A paltry nine per cent of Canadian adults — fewer than one in 10 — meet the criteria for “ideal” cardiovascular health, says a new study based on nearly half a million Canadians.

The heart health of the nation’s youth is only marginally better, with only 17 per cent of those aged 12 to 19 — fewer than one in five — getting top scores for healthy behaviours.

“Cardiovascular disease, which includes heart disease and stroke, is the second leading cause of death in Canada (after cancer) and is associated with disability, low quality of life and high economic costs,” researchers write in this week’s edition of the Canadian Medical Association Journal.

Twice as many women as men (13 per cent versus six per cent) were in ideal cardiovascular health over the study period, and the gender differences were even more pronounced in early middle age. Men scored lower than women on every measure except for physical activity, which was higher among males, and high blood pressure, which was similar between the sexes, the authors report.

Overall, the nation’s heart health grew worse moving west to east, with the best scores in British Columbia and the worst in Newfoundland and Labrador.

“We need to do better,” said senior author Dr. Jack Tu, a senior scientist with the Institute for Clinical Evaluative Sciences in Toronto and a cardiologist at Sunnybrook Health Sciences Centre.

Adults in ideal cardiovascular health had a 16 times lower prevalence of heart disease than those with the worst cardiovascular health, the team reports in the CMAJ. The differences “are huge,” Tu said.

The study used data from 464,883 people aged 12 and older who responded to Canadian Community Health Survey cycles between 2003 and 2011.

Researchers calculated heart health scores according to the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) index, which, for adults, uses six measures of “ideal” heart health: being a nonsmoker or former smoker who quit more than 12 months ago; having a body mass index (BMI) of less than 25; doing the equivalent of 30 minutes of walking per day; eating five or more servings of fruits and vegetables daily; and no diabetes or high blood pressure.

Scores ranged from zero (worst health) to six (best).

Over the study period, more adults were eating fruits and vegetables and exercising, and fewer people were smoking. But people got heavier, and the prevalence of diabetes and hypertension increased as well.

Overall, in 2009-2010, 9.4 per cent of Canadian adults were in ideal cardiovascular health, 53 per cent were graded “intermediate” (earning four or five points on the heart health scale) while 37 per cent were in poor cardiovascular health (zero to three healthy factors or behaviours).

There were significant regional differences: Mean scores decreased from a high of 4.1 in British Columbia, to a low of 3.5 in Newfoundland and Labrador, where obesity and smoking rates are among the worst in the country.

Nationwide, women had a distinct edge over men in early middle age: women aged 40 to 49 were three times more likely than men of the same age to be in ideal heart health (15 per vent versus five per cent).

However, the differences between men and women disappear by age 70.

For youth 12 and older, “ideal” heart health was defined as never having smoked, having a healthy weight, doing the equivalent of at least 60 minutes of walking daily and eating at least five servings of fruits and vegetables a day.

While there was a dramatic drop in youth smoking, almost half — 49.7 per cent — were in poor cardiovascular health.

Unhealthy behaviours in youth tend to be carried over into adulthood, Tu said. “Almost half the teenagers in the country aren’t doing at least an hour of physical activity a day, which is not consistent with the guidelines,” he said.

“This is the group that we have to be the most concerned about, because they will predict the future of cardiovascular disease in Canada.”

According to the Heart and Stroke Foundation, someone dies from heart disease or stroke every seven minutes in Canada.

“Up to 80 per cent of premature heart disease is preventable,” Bobbe Wood, president of the Heart and Stroke Foundation of Canada, said in a statement released with the study. “Unfortunately, almost four in 10 of us are in poor health. The good news is that by adopting healthy behaviour now, many Canadians can considerably reduce the effects of heart disease and stroke.”